title: Clinical determinants of ultrasound-guided sclerotherapy. Part II: In search of the ideal injectate volume.
abstract: BACKGROUND
  Ablation of the incompetent saphenous vein may be accomplished by either surgical extirpation or ultrasound-guided sclerotherapy (UGS). Procedural guidelines for optimizing UGS outcome have yet to be established for this relatively new procedure.
  
  
  OBJECTIVE
  To compare the effect of 1 vs 2 mL UGS sclerosant injectate volumes (SIV) on immediate vasospasm and later clinical outcome after UGS.
  
  
  METHODS
  UGS was performed on 56 patients with Class C2-4EPASPR venous insufficiency and duplex-confirmed saphenous junctional incompetence using 3% sodium tetradecyl sulphate (STS) and Class II compression. Group 1 received 1 mL SIV, and group 2 received 2 mL SIV. Treatment endpoint for both groups was persistent vasospasm observed on duplex imaging (15 mL maximum), with clinical and duplex follow-up at 2 weeks, 6 months, and 12 months.
  
  
  RESULTS
  The number of injections per treatment to achieve vasospasm (vasospastic dose) was unaffected by doubling the SIV. Group 2 had a higher recanalization rate than group 1. Several patients in group 2 experienced a transient febrile response shortly after treatment.
  
  
  CONCLUSIONS
  Using our UGS protocol to treat saphenous junctional incompetence, 2 mL SIV was less effective than 1 mL SIV, and was associated a minor adverse effect. The larger SIV did not induce more rapid vasospasm, and therefore did not lead to a reduction in the number of injections per treatment. The maximum safe STS dose/session is unknown, and deserves scientific study.
authors.affiliation: Vein Center of Orange County, Irvine, CA 92604, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kanter
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000000981:diagnostic imaging; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000379:methods; D012981:Sodium Tetradecyl Sulfate / Q000008:administration & dosage; D018084:Ultrasonography, Interventional; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate